Responding to Workplace Violence: Student Course

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1. Slide 1

   Responding to Workplace Violence in Healthcare

   • Options for when de-escalation doesn’t work
   • Summa Health 2021 Training Program
2. Slide 2

   Authorship and Disclaimer

   • Authorship
   • This course was developed by Summa Health in Akron, Ohio, and is a collaboration between Summa Health’s departments of nursing, emergency preparedness and protective services. For more information, contact Protective Services/Police Department at Summa Health.
   • Disclaimer
   • This material was produced under grant number SH-05150-SH9 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
3. Slide 3

   Introduction

   • Introduction and Warnings
   • Instructors
   • How we got here
   • Warnings
   • Violent sounds and images in simulations
   • Not a substitute for N.V.C.I.
   • (Non-Violent Crisis Intervention training)
   • No guarantee of survival or safety when concepts are applied in real life
4. Slide 4

   Initial Simulation

5. Slide 5

   Objectives

   • Objectives
   • To increase confidence in your reactions to violence by building a response framework
   • To move away from a victim mindset . . .
   • . . . and toward a Survivor mindset
6. Slide 6

   Mindset Sliding Scale

7. Slide 7

   What is Workplace Violence?

   • Definition
   • Occupational Safety and Health
   • Administration (OSHA) defines workplace violence as:
   • Any act or threat of physical violence, both verbal and nonverbal, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.
8. Slide 8

   In the healthcare environment, these acts and threats include incidents such as:

   • Incident Examples
   • Combative patients
   • Violent terminations
   • Domestic disputes
   • Homicidal or suicidal acts
   • Patient or family dissatisfaction, wrongful death
   • Chemically induced behavior (Narcan, intoxication)
9. Slide 9

   Statistics….

   • Statistics
   • According to the Online Journal of Issues in
   • Nursing (OJIN), nurses are ranked number one of employees in all industries experiencing workplace violence.
   • The Centers for Disease Control and Prevention
   • (CDC) states that nursing is the highest safety risk occupation.
10. Slide 10

    More Statistics . . .

    • More Statistics
    • According to OSHA, there are approximately 25,000 workplace violence assaults per year, 70-74% of which are against healthcare workers.
    • Due to under-reporting of assaults, these statistic is said to be low.
    • How many of you have been kicked, bitten, hit, had pudding thrown at you, grabbed, etc.?
11. Slide 11

    Will it happen here?

    • Simulation Video: Lobby
    • Click and Select Video #01 SIMULATION Hospital Lobby Active Shooter
12. Slide 12

    What would you do?

    • Question
    • With your patients?
    • Visitors?
    • Children?
13. Slide 13

    Past “crisis” training typically included:

    • Drills Historically
    • Tornado Drills
    • Fire Drills
    • Nuclear Air Raid Drills
14. Slide 14

    The Huddle Activity

    • Click to begin timer
15. Slide 15

    The Huddle

    • The Huddle Example Video
    • Click and Select Video #02 Huddle Observation Instruction Part 1
16. Slide 16

    Response Statistics

    • The average police response times to an active aggressor incident is 5 - 20 minutes in the United States
    • The average duration of incident with an active Shooter is 3 - 4 minutes
17. Slide 17

    Ask Yourself

    • What options did we choose?
    • What happened to our critical thinking?
18. Slide 18

    A.B.L.E.

    • Accept that it’s really happening, you cannot react until you accept the circumstance.
    • Barricade yourself and others in, so that the aggressor stays out.
    • Leave the area. Get as far away as possible.
    • Engage the aggressor, if you must, fight back.
19. Slide 19

    What do we do?

    • Crisis Starts
    • BOOM
    • When a balloon pops . . .
    • When someone slams a book on the desk . . .
    • When someone nearly hits you when changing lanes . . .
    • When a patient or visitor yells at or threatens you . . .
20. Slide 20

    Accept It

    • BOOM
    • Initial Choices
    • Don’t Accept
21. Slide 21

    = What does this mean?

    • Don’t Accept
    • Why we freeze
    • Why do people freeze?
    • No framework for the event
    • No similar life experience or training
    • Physical capabilities or limitations
    • Emotional capabilities or limitations
22. Slide 22

    Gift of Intuition

    • Intuition
    • Gut feeling
    • Mother’s intuition
    • Hair stands up on the back of your neck
    • Déjà vu
23. Slide 23

    Gut Feelings

    • Always trust your gut . . .
    • It knows what your head hasn’t yet figured out.
24. Slide 24

    Human vs. Animal

    • Trust your gut
    • High stakes predictions - we make them every day
    • Animals:
    • Always listen to “intuition” and . . .
    • run from danger
    • fight back when threatened or cornered
    • enact a self-defense mechanism
    • Humans:
    • Are the only species that ignore their intuition warning them of “DANGER”
25. Slide 25

    BOOM

    • Accept It
    • Accept It
    • Don’t Accept
    • Freeze
    • (NOT AN OPTION)
26. Slide 26

    Our options:

    • Options
    • A.B.L.E.
27. Slide 27

    A = Accept what is happening

    • A - Accept
    • quickly -
28. Slide 28

    A ccept It

    • It’s real
    • It’s happening
    • It’s real
    • This may take seconds or minutes.
    • Some events gradually build,
    • . . . while some events have “no-warning”
    • You won’t be able to REACT until you Accept the situation.
29. Slide 29

    A ccept It

    • React
    • BOOM
    • Don’t Accept
    • React
    • (help yourself, help others)
    • (NOT AN
    • OPTION )
30. Slide 30

    It’s your right!

    • Take control of your choices to be safe.
    • Take control of your choices to survive.
    • You have a responsibility to your family, friends, patients, and co-workers to survive!
    • You have the right to survive!
31. Slide 31

    Activate Emergency Response

    • Activate a call for help by:
    • Dialing
    • Your in-house emergency number
    • (Remember to dial for an outside line if needed)
    • Vocera or other personal communication device
    • (If available)
    • Using the Code Violet button on your phone
    • 9-1-1 or local emergency number
    • Place dialing instructions at each phone
32. Slide 32

    Program our emergency number into your cellular

    • Save the number
    • This number should appear first in your contacts.
33. Slide 33

    Be attentive

    • Describe this…
34. Slide 34

    What to report:

    • What to notice
    • Number of aggressors
    • Aggressor's description
    • Type of weapon(s)
    • Last known location
    • Direction of travel
35. Slide 35

    Let’s watch this scenario … .

    • Simulation Video: Patient Room
    • Would you do anything differently?
    • Click and Select Video #09 SIMULATION Patient Room Active Shooter
36. Slide 36

    A ccept It

    • React by barricading
    • BOOM
    • Don’t Accept
    • B arricade
    • React
    • (help yourself, help others)
    • (NOT AN
    • OPTION )
37. Slide 37

    B = Barricade - create a barrier

    • B - Barricade
    • between you and the aggressor
38. Slide 38

    Where can you barricade yourself?

    • Barricade options - levels
    • Facility
    • Wing/Division
    • Department/Suite
    • Office
    • Restroom/Closet
39. Slide 39

    Barricade options - items

    • How does your door operate?
    • What could you use?
40. Slide 40

    What is available?

    • Barricade options - examples
    • Beds/Desks
    • Beds
    • Belt
    • IV Tubing
    • Nightstands
    • Restraint Belts
41. Slide 41

    Hospital Lockdown Policy:

    • Lockdown Policy
    • The objective of lockdown is to control entry into the hospital while maintaining safety and service.
    • Partial lockdown: Protective Services will limit access into selected areas of the hospital by controlling entry points.
    • Full facility lockdown: Protective Services will limit access into all entry points.
42. Slide 42

    Know your exits

    • Know your EXITS and how to avoid the dangerous areas
43. Slide 43

    A ccept It

    • React by leaving
    • BOOM
    • Don’t Accept
    • L eave
    • B arricade
    • React
    • (help yourself, help others)
    • (NOT AN
    • OPTION )
44. Slide 44

    L = Leave - put as much distance as

    • L - Leave
    • possible between you and the aggressor
45. Slide 45

    Ambulatory Patients

    • Help patients leave
    • Leave is an option (RUN)
    • Leave through a predetermined evacuation route
    • Leave belongings behind
    • Know where your exits lead
    • Have a meet up location
46. Slide 46

    Barricade with patients

    • Non-Ambulatory Patients
    • Removing the patient may not be an option
    • Barricade or “defend” in place
    • Turn off lights
    • Silence cell phones
    • Block windows
    • Position behind cover
    • Treat injured if trained
    • Await directions
47. Slide 47

    Upon exiting the building:

    • When you do leave
    • Do not expect police to initially help you
    • Officers are trained to neutralize the threat
    • Rescue operations will arrive next
    • Do not have anything in your hands
    • Officers may point their gun at you
    • Raise your open hands so officers can see your empty hands
    • Treat the injured if you are trained
48. Slide 48

    What to expect

    • Expect that you:
    • May have weapons pointed at you May be searched
    • May be handcuffed
    • May be told to lay on the ground
49. Slide 49

    Break (10 minutes)

    • Break time
    • Next up:
    • Simulations…
50. Slide 50

    Simulation rules begin

    • Simulation Rules
    • Do not touch the actors
    • Do not throw anything
    • The Safe-Zone:
    • Outside of the room, and any other designated area
51. Slide 51

    Begin simulations

52. Slide 52

    Simulation review

53. Slide 53
    • The last resort
    • Finally, as a last resort,
    • and sometimes the only option . . .
54. Slide 54

    A ccept It

    • React by engaging
    • BOOM
    • Don’t Accept
    • L eave
    • B arricade
    • React
    • (help yourself, help others)
    • (Not an
    • option )
    • E ngage
55. Slide 55

    E - Engage

    • E = Engage - physically confront
    • aggressor as a last resort
56. Slide 56

    E ngage

    • You are strong
    • Tools to engage
    • You are strong, but you may not know it yet
    • You have an inner voice that is STRONG and directive
    • You have permission to “not be nice” to survive
    • You must believe that you are strong and will survive
57. Slide 57

    Tools to Engage (Continued)

    • Be powerful
    • Feel your balance
    • Learn to be a tactical breather
    • Always stand in a balanced fighting stance Power comes from the hips
    • Practice falling and getting up
    • Invest in your fitness
58. Slide 58

    Strikes

    • Engage: Hammer Fist
    • Hammer fist
    • Kick with balance
    • Always strike the midline of the body
    • The goal is to always get away
59. Slide 59

    How to use the Hammer Fist

60. Slide 60

    Hammer Fist Strike

    • Hammer Fist Video
    • Instructional Video
    • Click and Select Video #20 Tools to Engage Strikes Hammer Fist
61. Slide 61

    How to use the Hammer Fist.

62. Slide 62

    Wrist Grab

    • Engage: Snake & Vine
    • Snake and the vine Never pull someone toward you
63. Slide 63

    How to use the Snake & Vine

64. Slide 64

    Wrist Grab Defense

    • Snake & Vine Video
    • Instructional Video
    • Click and Select Video #21 Tools to Engage Wrist Grab Snake and the Vine
65. Slide 65

    How to use the Snake & Vine review

66. Slide 66

    Hair Pull / Grab

    • Engage: Be a Ballerina
    • Be a Ballerina
    • It’s all about the angles
67. Slide 67

    How to Be a Ballerina

68. Slide 68

    Hair Pull/Grab Defense

    • Be a Ballerina Video
    • Instructional Video
    • Click and Select Video #22 Tools to Engage Hair Pull Be a Ballerina
69. Slide 69

    How to Be a Ballerina review

70. Slide 70

    Front Choke Hold

    • Engage: Major League Pitcher
    • Major League pitcher Power from the hips
71. Slide 71

    How to be a ML Pitcher

72. Slide 72

    Front Choke Defense

    • Major League Pitcher Video
    • Instructional Video
    • Click and Select Video #23 Tools to Engage Front Choke Major League Pitcher
73. Slide 73

    How to be a ML Pitcher review

74. Slide 74

    Grab from Behind

    • Engage: Squash the Bug
    • Squash the bug Groin strikes
75. Slide 75

    How to Squash the Bug

76. Slide 76

    Grab from Behind Defense

    • Squash the Bug Video
    • Instructional Video
    • Click and Select Video #24 Tools to Engage Rear Choke Squash the Bug
77. Slide 77

    How to Squash the Bug review

78. Slide 78

    Just how good are the shooters?

    • Hit rates
    • Let’s see . . .
    • What is a trained officer’s hit rate?
79. Slide 79

    Distraction . . . What Causes a Reaction?

    • How to distract a shooter
    • Click and Select Video #26 Distraction What Causes a Reaction
80. Slide 80

    Distraction and aim

    • Just how good are the shooters?
81. Slide 81

    What Could You Use As A Distraction?

    • What can you throw?
    • Soda Cans
    • Food Trays
    • Laptop
    • IV Pole
    • Charts
    • Lunch Bags
    • Phone
    • Stapler
    • Book Bags
    • Keyboard
82. Slide 82

    Authority

    • Authority granted
    • Authority must be given to employees
    • Employees must give themselves authority
83. Slide 83

    Engage: The Swarm

    • Very simple and effective tactic: The Swarm
    • The goal is to control 3 points:
    • Arms
    • Legs
    • Head
84. Slide 84

    The Swarm Demonstration

    • The Swarm Video Demo
    • Click and Select Video #25 SIMULATION Swarm Maneuver Demo
85. Slide 85

    How to Swarm

86. Slide 86

    The Swarm

    • The Swarm Video
    • Instructional Video
    • Click and Select Video #27 Tools to Engage Weapon Swarm Maneuver
87. Slide 87

    How to Swarm review

88. Slide 88

    Hostage:

    • Hostage Situations
    • If you are taken hostage:
    • Be patient
    • Be alert and follow instructions
    • Do not speak unless spoken to
    • Avoid arguments or appearing hostile
    • Conserve your energy
    • Be observant
89. Slide 89

    A ccept It

    • A.B.L.E. Recap
    • BOOM
    • Don’t Accept
    • L eave
    • B arricade
    • React
    • (help yourself & help others)
    • (Not an option )
    • E ngage
90. Slide 90

    Review of Objectives

    • Review Objectives
    • To increase confidence in your reactions to a crisis by building a framework of options
    • Accept that its happening and take action.
    • Options for fire drills and tornados do not fit options for violent people
    • Barricade . . . Leave . . . Engage
    • To move away from a Victim Mindset . . .
    • . . . and toward a Survival Mindset
    • React to your intuition - that gut feeling
    • You have a right and duty to survive
91. Slide 91

    Confirming Statement

    • When confronted with violence, I will NOT FREEZE.
    • I will take action, and I will survive.
92. Slide 92

    Questions and Feedback